Tuesday, October 06, 2009

Today I'm going to offer you a list of things I feel are worth acting on. While certainly you may not agree with the order or even every item on the list, surely there'll be at least one or two hills here that you may want to take stands on and as far as I'm concerned these are 10 nutritional hills worth dying on.

1.An evidence based Food Guide.

While the Food Guide may not be taped on every fridge it's still hugely important. It helps to shape national nutrition policies and industry programs, and serves as the backdrop against which every food related news story is published. It is what's taught to our children in schools, it dictates what's served to patients in nursing homes and hospitals, it becomes the basis for industry based food health claims and front-of-package labels. In short it becomes Canada's nutritional consciousness and given how infrequently it's revised (15 years this past time around), if it's wrong it'll misinform and undermine good nutrition in Canada for a decade or more.

And really, errors? Pardon me but how the !*&# can there be errors in a document that should simply be a reflection of our best available evidence and moreover, how the !&*# did it take them nearly 2 years to churn out the piece of drek we're now stuck with?

I truly believe that the noise and negative coverage surrounding the launch of the 2007 Food Guide has served to pave the way for a robust overhaul the next time around. Your job is to point out the Food Guide's unacceptable weaknesses whenever possible and promote its early review.

Canada is one of very few Western nations that does not support a publicly funded national meal program for its students. It has been shown that school food programs markedly improve the mental and physical well being of students who utilize them with some reporting increases in standardized test scores, less illness, better discipline and improved alertness. According to Canada's Chief Medical Officer of Health,

"When children go to school hungry or poorly nourished, their energy levels, memory, problem-solving skills, creativity, concentration and behaviour are all negatively impacted. Studies have shown that 31% of elementary students and 62% of secondary school students do not eat a nutritious breakfast before school. Almost one quarter of Canadian children in Grade 4 do not eat breakfast daily and, by Grade 8, that number jumps to almost half of all girls. The reasons for this vary – from a lack of available food or nutritious options in low-income homes, to poor eating choices made by children and/or their caregivers. As a result of being hungry at school, these children may not reach their full developmental potential – an outcome that can have a health impact throughout their entire lives"

Reading his words one can only hope that in the backrooms he's vigorously lobbying for such a program and so should you.

3. A national trans-fat ban

Marni Soupcoff's personalized and juvenile arguments from the National Post two days ago notwithstanding, trans-fat is an unnecessary food additive that is toxic in any amount. Not only would removing it from the food supply directly impact on reducing unnecessary deaths, but studies also suggest that its removal will also have the indirect benefit of causing an increase in healthy fats consumed.

It's estimated that 6,000 Canadians die annually as a consequence of trans-fat in our food supply and Canada's asinine 2 year free pass monitoring program has proven that industry as a whole is not in fact uniformly removing it.

Your job - again, support the ban, shoot down moronic discourse like Marni's by pointing out that it's not a matter of nannying for the state to suggest we remove a toxic food additive that has less/non toxic alternatives, and call your MP to let them know you support Mme Gelinas' Private Member’s Bill 156, Healthy Decisions for Healthy Eating Act.

4. Mandatory menu-board calories

Plainly put, calories are the currency of weight. Given that it is now no longer normal to have a healthy body weight (between 60-70% of North America is now overweight or obese) interventions geared towards educating the public about energy are crucial. Perhaps none are more important than menu-board calories as it has been shown that not only do people make different choices when faced with menu-posted calories, but restaurant chains respond to the subsequent customer demand for lower calorie choices by designing new lower calorie options and modifying older higher calories ones. Given the 54% of our food dollars now go to food eaten outside of the home, clearly this is a huge hill.

It's important to point out here that this hill isn't an "anti-calorie" hill, it's a pro-education hill. You can't roll out an intervention like this one without a concomitant campaign that educates Canadians about how many calories their bodies need per meal, per snack and per day, a campaign which would lend itself handily to a web-based energy expenditure calculator page. The calories are not meant to be used for judgment, just guidance similar to the way consumers currently utilize price tags to guide their purchasing decisions. (Update: More on this tomorrow to discuss recent finding that in the poorest neighbourhoods in the US, this doesn't seem to help)

Your job would be to support mandatory calorie postings by means of speaking up and countering the hollow arguments that tend to suggest that it will be an anti-calorie campaign, to speak to your school boards to support the Ontario Medical Association's call to put calories in school cafeterias and if you're in Ontario to call or write your MP and let them know you support Mme Gelinas' Private Member’s Bill 156, Healthy Decisions for Healthy Eating Act that calls for both mandatory menuboard calories as well as a trans-fat ban.

5. The establishment of soda taxes

There's zero doubt that sugar-sweetened beverages are a major contributor to the current default annual weight gain of society. There's also no doubt they contribute to the burden of societal chronic disease. Nanny state alarmists tend to try to paint soda taxes as a draconian cash grab and an infringement of civil liberties, but really what's being called for is a nominal tax on beverage manufacturers for each ounce of sugar-sweetened beverages produced. The most recently proposed amount was a penny an ounce which would raise the cost of a can of soda by roughly 12 cents. Hardly a huge amount of money for each individual but likely to generate well over $1 billion annually in Canada which if utilized to fund such things as a National School Food Program, would be an unbelievably beneficial tax (and according to studies would also result in a 10% decrease in national soda consumption).

Your job - think critically about it, challenge the folks who kneejerk when they hear the word tax and if the opportunity ever arises that we're actually considering this as a federal program, call your MP and tell them what you think.

6. A robust and evidence-based front-of-package labeling program

To quote from the movie Highlander, "There can be only one", or at least that's how it should be. The glut of front-of-package labeling dilutes the utility of all of them, and given all of Canada's options are awful, we're really behind the eight ball here where at least in the States there are two evidence-based, shielded from industry options to consider - Hannaford Brothers' Guiding Stars and my personal favourite, Nuval.

Frankly I think zero options would be better than our current Canadian options and consequently I would certainly support a ban on front-of-package labels though of course my preference would be to not reinvent the wheel and instead for the government to provide incentives to supermarket chains to license the Nuval algorithm and score every single item on their shelves (as is being done in American Price Chopper, Hy Vee and Meijer stores).

In case you're not sure what Nuval is, it's an algorithm developed by some of the world's leading epidemiologists and nutritionists that generates a weighted score of 30 different nutrients and yields a number between 1-100. Dead simple to use, the higher the number, the healthier the food. Incredibly useful as most people don't have the background or the time to properly evaluate food labels.

Given that's a pipe dream perhaps the best you can do is to educate your colleagues, friends, families and patients about the uselessness of current Canadian front-of-label programs and were the opportunity arise, introduce them to our healthier American alternatives.

7. A ban on school/hospital/civic junk food

Do we sell cigarettes in schools, hospitals, community centres, hockey arenas and libraries? No? That would be crazy? How is that any crazier than selling foods with mind-numbing amounts of sodium and/or trans-fats that are unquestionably contributors to the growing burden of chronic diseases in Canada?

The only possible reason for their sale in such centres is profit, but given we live in a country with socialized medicine, I would argue that the sale of disease-inducing garbage to our children in our schools, community centres, hockey arenas and libraries almost certainly cost society more in long-term consequences than the profits they generate at point of sale. Of course that also assumes that one can't sell healthy foods for profit which is an idiotic and defeatist attitude.

The fact that children have to complain about the hypocrisy of the foods their lunch room serves versus the foods they're taught are and aren't healthy before they see change is unconscionable.

This of course goes hand in hand with the development of a national school food program but given that I don't see that one coming down the pipes anytime soon for now I'd argue your job is to meet with school principals and superintendents, write letters to the editor, go on clandestine trips with cameras and shame people into action. Profits should not be made or considered on the backs of our children's health.

8. A national ban on advertising targeting children

Plain and simple, young children are not able to discern the difference between truth and advertising and consequently I believe it's entirely unethical to allow marketers to target them. Furthermore food, and specifically unhealthy food, is the number one source of television commercials seen by children. Frankly to me whether or not they impact childhood obesity rates (they do) is besides the point as I think targeting children period is unethical.

Currently I'm not aware of any politicians considering an advertising ban. Until then, have discussions with your children's schools regarding the inclusion of courses meant to teach kids how to critically analyze commercials and certainly, even at a very young age, start teaching them yourselves. Our 5 year old certainly knows what commercials are and what they set out to do (though she still wants me to buy her some Cinnamon Toast Crunch).

9. A robust natural products directorate

The need for this was highlighted last week in Macleans magazine where it was revealed that,

"products can obtain a federal licence number—what surely looks to consumers like a government seal-of-approval on the label—on the basis of old beliefs",

the translation of which means that if someone, sometime, somewhere was using pine needles to treat herpes then you can bottle up all the needles you want and sell them, absence of evidence be damned, to any one you damn well please, all with the government's blessing.

I think Macleans' John Geddes hit it right on the head when he stated,

"It has never made sense to me that Health Canada is validating traditional-use claims. Health Canada should be in the business of applying science to regulation."

No indeed, it doesn't make sense.

In terms of what you can do, currently Health Canada has set a 2010 deadline of licensing all Canadian natural health products. Why not take a moment or two to write your MP and tell him how you believe that licenses should only be granted on the basis of robust evidence supporting the claim as otherwise all Health Canada will be doing is perpetuating health care fraud.

10. A robust food health claims division

To be honest, I'm not entirely clear on the process we have right now. Here's what I do know:

I know Danone (Dannon for my American readers) recently withdrew its health claims regarding the probiotics it puts in Activia (regularity) and Danactive (immunity) from consideration in the new, stricter, European Union health claims commission. I also know Danone recently settled a class action lawsuit regarding those same claims in the US to the tune of $35 million and I know that yet here in Canada Activia and Danactive are still being actively marketed with their EU retracted and US sued claims intact.

I know with Nestle we've got the Canadian Food Inspection Agency asking Health Canada to revoke the right of infant formula makers to brag and make health claims about their DHA additions unless those additions are included in amounts consistent with the benefits seen in medical literature. And I know that Similac Advance doesn't meet those amounts and yet still reports it's DHA inclusion will help baby's brain and eyes develop. I know Health Canada by the way took a pass on CFIA's request.

Lastly I know that according to CBC's Investigative Consumer show Marketplace one would have to consume 214 slices of Wonder Bread Head Start to get the equivalent amount of DHA as would be found in 75grams of salmon yet Wonder Bread Head Start still actively targets parents with their promises of smarter kids with statements like,

"Give your little ones a headstart! New Wonder+ Headstart has the fresh Wonder taste they love PLUS all the benefits of Omega-3 DHA which helps in the normal development of the brain, eyes and nerves."

Clearly if we actually have a system, something's very wrong with it. In terms of what you can do about it, here I'm a bit of a loss. I'm really unsure who to complain to if the CFIA gets ignored by the folks over at Health Canada. Here I need enlightenment and certainly if you're reading this, and happen to know who/how/why things get done the way they do with health claims in Canada, leave a comment for me and my readers to help me mobilize thoughts and efforts.

So there you have it - my top ten list of nutritional hills worth dying on. Such an incredibly sad statement that we need to actually fight for any of these causes given that a Health Canada truly dedicated to the health of Canadians would have had them all covered ages ago and done our fighting for us.

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About Me

Family doc, Assistant Prof. at the University of Ottawa, Author of The Diet Fix, and founder of Ottawa's non-surgical Bariatric Medical Institute - a multi-disciplinary, ethical, evidence-based nutrition and weight management centre. Nowadays I'm more likely to stop drugs than start them. You can also find me on Twitter and Facebook.

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